Ketamine is becoming increasingly popular for off-label use, but caution still must be exercised

Patients in intensive care units can have one other alternative for pain control and sedation in the shape of a drug approved as an anesthetic nearly 50 years ago.

According to a Press Release from the American Association of Critical Care Nurses, which highlights the outcomes of a recent study on drug administration in intensive care units. There has been a major increase in off-label use of ketamine in clinical settings because of concerns about addiction and respiratory depression related to traditional sedatives. including opioids and benzodiazepines.

Checking options

Study, named Ketamine use within the intensive care unitexamines properties that will make the drug a possible sedation option for quite a lot of procedures, including:

• The rapid onset of motion and short duration of motion could also be particularly useful for brief, painful procedures.
• Trance-like sedation can assist patients not remember painful or difficult procedures.
• Additional pain control may reduce the necessity for opioids.
• The effect on respiration may help avoid the necessity for invasive respiratory support.

According to the press release, negative effects that 20% of patients may experience after taking ketamine include severe agitation while recovering from sedation, including disorientation, strange dreams and hallucinations. Despite ketamine’s benefits over other sedatives, this phenomenon that happens during recovery from sedation is a major reason why its use shouldn’t be more common, the press release stated. “The entire critical care team must be familiar with ketamine’s various off-label uses and dosing strategies,” co-author Sarah Nelson, PharmD, BCPS, BCCCP, a clinical pharmacist and intensivist within the department of pharmacy at Mayo Clinic, said in a news release in Rochester, State Minnesota.

“As the widespread use of ketamine increases, nurses and other caregivers need to understand its unique characteristics and the impact it can have on patients,” Nelson said.

The study mentioned the recreational use of ketamine and the way increasing reports of abuse of the drug within the Nineties led the FDA to reclassify it as a Schedule III controlled substance. “Despite concerns about drug diversion or abuse, the number of clinical and experimental uses of ketamine in various patient populations has increased significantly over the past decade,” the study authors wrote. “This increase is due in part to ketamine’s unique pharmacological profile.”

As a drugs for depression

While support for ketamine, known in partisan circles as “special K” for illicit use, has also grown as a possible treatment for depression, Stanford University researchers advise caution, in response to a recent study Article in Fortune magazine. The article, published on August 29, 2018, cites research published within the American Journal of Psychology that found that ketamine’s biology helps it act as an efficient antidepressant.

“Essentially, researchers concluded that for ketamine treatment to actually work in depressed patients, it must activate the body’s opioid system,” the article says.

Other articlepublished September 6, 2018 in Becker’s Hospital Review, also cites the American Journal of Psychology stating that ketamine it acts on the brain like an opioid. The evaluation showed that seven of the 12 patients had a discount in depressive symptoms by roughly 50% after taking ketamine, the writer wrote. “The study suggests that ketamine’s effectiveness in treating depression is due to the drug’s interaction with the brain’s opioid system,” the article says. “Ketamine’s effects on opioid receptors may provide immediate, short-term relief from depression symptoms,” the researchers say. Although ketamine has demonstrated off-label safety, the authors note that monitoring for respiratory depression and drug negative effects must be routine, states an AACN press release. Full details of the study have been published within the journal Medication update column within the Summer 2018 issue of AACN Advanced Critical Care, often specializing in critical care medications.

Sedation and depression courses

Advances in technology give us quick access to a wealth of data to support evidence-based practice. With access to those resources, nurses can provide patients with one of the best evidence-based interventions and coverings. This continuing education module reviews the evidence underlying three practices: respiratory testing for patients undergoing mechanical ventilation, CLABSI prevention, and early feeding of critically in poor health patients. To effectively and safely take part in the administration of moderate intravenous sedation, RNs must have the option to differentiate between levels of sedation/analgesia; exhibit competence in pre-operative, procedural and post-operative nursing care; anticipate and reply to patient emergencies during sedation; and understand the medico-legal elements of sedation/analgesia. This module will address and define the several levels of sedation, the care of patients through the moderate sedation continuum of care, and the suitable medications to attain moderate sedation. National health surveys show that one in 20 Americans over the age of 12 has experienced depression previously 12 months. There are concerns about a rise in depression and suicide rates amongst adults aged 24-59. The World Health Organization states that depression ranks third when it comes to global burden of disease and predicts that by 2030 it’ll be in first place. In 2013, 41,149 people died by suicide within the United States. The variety of suicide attempts is of significant concern – 25 times higher than the variety of suicides. Early detection, assessment and effective intervention are essential within the care of patients with physical illnesses who may suffer from depression. Patients affected by somatic diseases are vulnerable to depression, and depression can complicate treatment and hinder effective regeneration. Underdiagnosed and poorly treated depression can have a huge effect on the resources of each the patient and his family.